Using grounded mindfulness to cope with anxiety: Case example

Anxiety causes a great deal of distress and suffering. I find in my individual counseling practice in Washington DC that a common problem with anxiety is impaired attention. The sufferer not only pays excessive attention to distressful thoughts and feelings, but also the quality of attention is often associated with self-judgment and apprehensive expectations about things to come.

Techniques learned in individual counseling Bethesda MD sessions like deep/slow breathing and grounding can be highly effective in managing anxiety. Underlying these approaches is a quality of attention or mindfulness that helps one develop a more accepting and non-judgmental relationship to private thoughts and feelings. Mindfulness helps in gaining separation from worry, edginess and tension; the inner distance acquired allows for the development of adaptive ways of coping with anxiety, such as identifying the source of the anxiety, finding reassurance and discovering problem solving.

The excessive worry and thinking associated with anxiety may be experienced as an upward rise of energy, as if there were too much energy in the head (lots of thoughts) and in the chest (tension and fear); it is like losing one’s footing (grounding) psychologically and emotionally. Deep/slow breathing and grounding (a sensing and imaging technique) provides one with a way to lower the psychological center of gravity into our body, thereby connecting us more securely to the ground; by regaining “our footing,” it stabilizes and relaxes us.

An integral part of breathing is mindfulness, a shifting of attention from worry and tension to sensing and imaging, toward finding adaptive and positive pathways of experiencing. In addition, the shift of attention increases the distance from the worry and tension; this allows us to manage and tolerate distressful feelings, to develop self-acceptance and self-confidence, and to reduce self-judgment by identifying the sources of anxiety and developing adaptive ways of coping. An example may best illustrate this process. Lena’s name is fictitious, and her personal history has been disguised to keep her identity confidential.

Lena is thirty-five years old. She is recently divorced and lives with her three children. Lena receives child support, and she also runs a part-time consulting business from her home. After the births of her last two children, Lena became weaker and depressed, and she developed several physical problems. More recently, after her divorce, she became anxious and experienced several panic attacks. Despite all of these stressors, Lena pushes herself constantly, always being busy. She is a wonderful and responsible mother, but she has a hard time taking care of herself. Her anxiety, panic and underlying depression compound her life and work challenges. Realizing it was essential for her to take better care of her own health and to develop better ways to manage her depression, her anxiety and panic, she decided to go to therapy.

Grounded mindfulness gave her a way to calm herself. The deep breathing helped her learn to relax, the grounding calmed her. She learned to nurture herself in this way, but the deep breathing also gave her a way to learn to identify more with experiences of well-being and less with every day distresses – a shift of attention.

This shifting of attention gave her distance from her distress, and she began to have more and more insights about the sources of her distress. She has always been very hard on herself and highly self-critical; giving herself credit for her accomplishments was not acceptable. Further magnifying this negative attitude, both her mother and her ex-husband have been very critical and rejecting of her views. Throughout her life she has believed that she is unworthy or not good enough; these beliefs often made her feel helpless and hopeless. She coped with this pain by pushing herself to do and endure more, which in turn made her feel more tired and distressed. It became obvious that this manner of coping did not undo the stresses caused by the way she was seeing and treating herself.

Recently, she became keenly aware of this destructive cycle when her ex-husband came to pick up the kids. She witnessed herself getting tense, and when he left, she began to work furiously around the house. But this time, the time she had spent practicing grounded mindfulness began to pay off. At one point, she stopped herself and asked, “What’s going on?” She became conscious of her self-judgments (not good enough, worthless, and sick) and of her attempt to suppress those thoughts and feelings through her busyness. It was quite a revelation for her.

Next day, when she got to my office, she was nervous but excited about her discoveries. In previous sessions, we had worked with her self-judgments, and with a technique for accepting and loving herself. In this session, after deep breathing and grounding we began to work in a deeper way with her judgmental side; she could now see this part of herself with more distance. Having more inner space, she could now dialogue with her inner judgment (her inner critic) more effectively, as if it were another person. She learned more about the nature of the critic in her – how it constantly pushed her to do more, to get better health right away, or to find fault with herself no matter how well she was doing.

More importantly, she discovered how this habitual old response would silence her personal expression. Lena had great difficulty in speaking up and setting boundaries. In the past, when she would stand up for herself with her husband, her words would often be turned around against her. Lena was usually blamed for all the problems, and she was often emotionally abused. It was not uncommon for her to suppress herself – “I can’t say anything….maybe I am just a bad wife.”

Out of this confrontation with herself, Lena has grown more self-accepting and self-loving. Her ability to speak up on her own behalf has increased. Lena also began to feel less pressure “to get better.” She found that her inner critic was illusory. Lena described this as poking a balloon with a pin; its power deflates and diminishes. Furthermore, Lena’s insights gave her a better understanding of her relationship with her mother, allowing her to see the similarities in her relationships with her ex-husband and her mother. These insights have allowed her to be more grounded, more self-confident, and more secure in herself. Quieting her inner critic has reduced her anxiety, and her newly developed self-perspective has given her the freedom to be more healthy and able to better care for herself.